tbuckley/cabot-search huggingface dataset:
Socioeconomic inequalities of Long COVID: a retrospective population-based cohort study in the United Kingdom
Authors: Sharmin Shabnam, Cameron Razieh, Hajira Dambha-Miller, Tom Yates, Clare Gillies, Yogini V Chudasama, Manish Pareek, Amitava Banerjee, Ichiro Kawachi, Ben Lacey, Eva JA Morris, Martin White, Francesco Zaccardi, Kamlesh Khunti, Nazrul Islam
Journal: Journal of the Royal Society of Medicine (2023)

Objectives To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the inequality by sex and occupation. Design We conducted a retrospective population-based cohort study using data from the ONS COVID-19 Infection Survey between 26 April 2020 and 31 January 2022. This is the largest nationally representative survey of COVID-19 in the UK with longitudinal data on occupation, COVID-19 exposure and Long COVID. Setting Community-based survey in the UK. Participants A total of 201,799 participants aged 16 to 64 years and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Main outcome measures The risk of Long COVID at least 4 weeks after SARS-CoV-2 infection by index of multiple deprivation (IMD) and the modifying effects of socioeconomic deprivation by sex and occupation. Results Nearly 10% ( n = 19,315) of participants reported having Long COVID. Multivariable logistic regression models, adjusted for a range of variables (demographic, co-morbidity and time), showed that participants in the most deprived decile had a higher risk of Long COVID (11.4% vs. 8.2%; adjusted odds ratio (aOR): 1.46; 95% confidence interval (CI): 1.34, 1.59) compared to the least deprived decile. Significantly higher inequalities (most vs. least deprived decile) in Long COVID existed in healthcare and patient-facing roles (aOR: 1.76; 95% CI: 1.27, 2.44), in the education sector (aOR: 1.68; 95% CI: 1.31, 2.16) and in women (aOR: 1.56; 95% CI: 1.40, 1.73) than men (aOR: 1.32; 95% CI: 1.15, 1.51). Conclusions This study provides insights into the heterogeneous degree of inequality in Long COVID by deprivation, sex and occupation. These findings will help inform public health policies and interventions in incorporating a social justice and health inequality lens.
Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study
Authors: Wenxin Yan, Chenyuan Qin, Liyuan Tao, Xin Guo, Qiao Liu, Min Du, Lin Zhu, Zhongdan Chen, Wannian Liang, Min Liu, Jue Liu
Journal: BMJ (2023)

To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019.Observational study.172 countries and territories.Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data.The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH.Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers.Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.
Matrisomic characterization of HCC to inform individualized patient management
Authors: Hiroaki Kanzaki, Courtney Katz, Yujin Hoshida
Journal: Hepatology (2023)

1Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan 2Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S Correspondence Yujin Hoshida, Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA. Email: [email protected]
Molecular testing-guided therapy versus susceptibility testing-guided therapy in first-line and third-line Helicobacter pylori eradication: two multicentre, open-label, randomised controlled, non-inferiority trials
Authors: Mei-Jyh Chen, Po-Yueh Chen, Yu-Jen Fang, Ming-Jong Bair, Chieh-Chang Chen, Chien-Chuan Chen, Tsung-Hua Yang, Ji-Yuh Lee, Chien-Chun Yu, Chia-Chi Kuo, Min-Chin Chiu, Chu-Kuang Chou, Chi-Yi Chen, Wen-Hao Hu, Min-Horn Tsai, Yao-Chun Hsu, Chia-Tung Shun, Jiing-Chyuan Luo, Jaw-Town Lin, Emad M El-Omar, Ming-Shiang Wu, Jyh-Ming Liou
Journal: The Lancet. Gastroenterology & hepatology (2023)
Immunogenicity of novel oral poliovirus vaccine type 2 administered concomitantly with bivalent oral poliovirus vaccine: an open-label, non-inferiority, randomised, controlled trial
Authors: Amanda L Wilkinson, Khalequ Zaman, Masuma Hoque, Concepcion F Estivariz, Cara C Burns, Jennifer L Konopka-Anstadt, Bernardo A Mainou, Stephanie D Kovacs, Qian An, Jacquelyn S Lickness, Mohammad Yunus, Cynthia J Snider, Yiting Zhang, Elizabeth Coffee, Talha Abid, Steven G F Wassilak, Mark A Pallansch, M Steven Oberste, John F Vertefeuille, Abhijeet Anand
Journal: The Lancet Infectious Diseases (2023)
P43 CIRCULATING CLONAL PLASMA CELLS AT START OF SALVAGE REGIMEN PROVIDE POWERFUL PROGNOSTICATION BIOMARKER IN MULTIPLE MYELOMA PATIENTS AT FIRST RELAPSE
Authors: A. Romano, N. L. Parrinello, G. Scandura, S. Marino, A. Triolo, V. Del Fabro, F. Di Raimondo, C. Conticello
Journal: HemaSphere (2023)

Introduction: There is a growing interest in investigating the clinical impact of circulating clonal plasma cells (CCPC) quantitation reflecting the tumor burden in multiple myeloma (MM), due to its easy access and non-invasive nature. Recent studies have highlighted the value of quantification of CCPC at diagnosis for risk stratification of transplant eligible and not MM. However, prospective data on the real-world utility of CCPC quantitation in relapsed-refractory patients (RRMM) treated with novel immunotherapies is extremely scarce. Aims: To investigate the prognostic value of CCPC quantitation in treated with novel immunotherapies using high-sensitivity multicolor-flowcytometry (HS-MFC) and the relevance of their assessment in predicting overall survival (OS). Methods: We prospectively evaluated 44 consecutive MM patients requiring first salvage regimen containing daratumumab from July 2018 through July 2021 (age: median-65 years; range-44-81 years; M/F-30/14). CCPC levels were studied using 10-13 color HS-MFC (sensitivity- 0.0001% or 1x10e- 6) at the start of the salvage regimen. CCPC levels were calculated as CCPC percentages in total WBCs (%CCPC/WBC). The cut-off value was identified using ROC analysis against OS. Initial therapeutic response (ITR) was monitored at the end of the second cycle of treatment. Results: The median follow-up was 46 months (range 1-51 months). ITR included CR-VGPR 6.5%, VGPR/PR-63.0%, SD-21.7%, and 4 (8.7%) patients died during initial therapy. CCPCs were detected in all patients. Median %CCPC/WBC was 0.41% (range, 0.004-6%). CCPCs from patients with higher LDH and extra-medullary disease carried significant lower amount of CD27 and CD81 and higher amount of CD200 although no difference in the percentage of CCPCs was recorded. %CCPC/WBC ≥0.4% was strongly associated with OS (27.1 months vs 48.5; HR-2.5; p=0.04). Conclusion: This prospective study showed that CCPC quantification (≥0.4% of WBC) at start of daratumumab-based salvage regimen in RRMM patients treated at the first relapse provides a powerful independent biomarker for the prediction of OS. Such assessment is more convenient for routine clinical practice and should be confirmed in larger studies.
MONOCLONAL GAMMOPATHY OF CLINICAL SIGNIFICANCE
Authors: J. Bladé
Journal: HemaSphere (2023)

Aside from the risk to evolve to MM or WM, or to be associated with AL amyloidosis or POEMS syndrome, the M-protein in persons with MGUS can cause “per se” the so-called “monoclonal gammopathies of clinical significance –MGCS” resulting in neurologic, skin, ocular, bleeding or other disorders. The monoclonal gammopathy of renal significance (MGRS), coined to highlight renal damage, different from cast nephropathy or amyloid deposition, linked to the M-protein is not discussed here. In patients with MGUS and peripheral neuropathy (PN), and no evidence of AL amyloidosis or POEMS, a causal relationship must be considered. In the IgM type, a gammopathy-associated PN is likely (50% are MAG positive) while in the IgG and IgA types a CIDP with coincidental MGUS is the most likely diagnosis. The main skin conditions related to M-proteins are: 1) cryoglobulin (IgG/IgM) vasculatis with petechiae, purpura or ulcers, 2) Schnitzler syndrome (IgM, chronic urticaria, fever, artralgia), 3) pyoderma gangrenosum (IgA, ulcers with central necrosis), 4) necrobiotic xanthogranuloma (IgG, yellow papules, nodules, plaques), 5) escleromixedema (IgG-lambda, mucine dermal deposition with occasional systemic involvement –cardiomyopathy, pulmonary fibrosis or reduced esophageal motility-) or 6) acquired generalized cutis laxa (lambda, elastolysis of the skin –premature ageing-, occasionally associated with kidney –fibrillar glomerulopathy-, heart or lung involvement). The most frequent ocular M-protein related condition is crystalline keratopathy (Ig deposition, corneal thickening, photophobia, visual loss). Bleeding can result from acquired von Willebrand deficiency or by impaired platelet aggregation induced by the M-protein. In summary, The M-protein in MGUS can cause relevant clinical conditions. If a causal relationship is proven or highly suspected, therapy against the plasma cell clone (rituximab-based in IgM-types and bortezomib-based, even including ASCT, in non-IgM) must be timely initiated.
BONE DISEASE
Authors: E. Terpos
Journal: HemaSphere (2023)

Osteolytic bone disease is the most common complication of multiple myeloma. Both diagnosis and follow up of bone disease during anti-myeloma therapy require modern imaging. Bone targeted agents should be administered in all newly-diagnosed myeloma patients with myeloma-related bone disease. Zoledronic acid should be given even in newly-diagnosed patients without bone disease and it is preferred over other bisphosphonates due to its survival advantage. Zoledronic acid is administered monthly. However, once patients achieve VGPR or better, the treating physician may consider decreasing frequency of dosing to every 3 months or based on osteoporosis recommendations (every 6 months or yearly), or even to discontinue therapy if the patient has received one year of monthly zoledronic acid. Bisphosphonates should be re-administered at a monthly schedule at the time of relapse, if new evidence of bone disease is present. Denosumab can also be considered for the treatment of myeloma-related bone disease, particularly in patients with renal impairment. In the largest placebo-controlled trial for myeloma patients to-date, denosumab was compared to zoledronic acid. Although, there was no difference regarding time to first skeletal-related event, a landmark analysis at 15 months showed a superiority of denosumab in terms of SREs. Denosumab may also prolong PFS among newly-diagnosed patients with bone disease, who are eligible for autologous transplantation. Denosumab should be administered as a subcutaneous injection of 120mg at monthly intervals continuously, according to its label. Dosing de-intensification or drug holiday or discontinuation might be considered only after 24 months of treatment and if patient has responded to anti-MM treatment defined as VGPR or better. Discontinuation of denosumab is challenging due to the rebound phenomenon observed in osteoporosis patients. In this case, and until further data is available on myeloma patients, a single dose of iv bisphosphonate (i.e. zoledronic acid) is recommended at least 6 months after the last denosumab dose in order to prevent a potential rebound effect; Newly-diagnosed patients at high risk for developing skeletal-related events should be considered for an early intervention in addition to the administration of bone-targeting agents. Balloon kyphoplasty and vertebroplasty are recommended for patients with painful vertebral compression fractures. Radiotherapy should be considered for uncontrolled pain due to impeding or symptomatic spinal cord compression and due to pathological fractures. Surgery should be considered for prevention and restoration of long-bone pathological fractures, vertebral column instability and spinal cord compression with bone fragments within the spinal route.
Reply: Is there survival bias? The etiologic analysis for the negative association between fatty liver and mortality in the elderly populations
Authors: Laurens A. van Kleef, Milan J. Sonneveld, Robert J. de Knegt
Journal: Hepatology (2023)

Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands Role of the funding source. Financial support was provided by the Foundation for Liver and Gastrointestinal Research, Rotterdam, the Netherlands. The funding source did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication. Correspondence L.A. van Kleef, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Email: [email protected]
MGRS: DIAGNOSIS AND TREATMENT
Authors: F. Bridoux
Journal: HemaSphere (2023)

Monoclonal gammopathy of renal significance (MGRS) refers to the association of a small, otherwise indolent B-cell clone, with renal disease induced by the secreted monoclonal Ig (MIg). Renal lesions, independent of the tumor burden, are governed by the physico-chemical characteristics of the MIg and involve either direct (MIg deposition or precipitation) or indirect (autoantibody activity, complement activation) mechanisms. The spectrum of MGRS-associated renal disorders is wide, encompassing tubulo-interstitial disorders (Fanconi syndrome, crystal storing histiocytosis) and glomerular disorders. The latter are classified into 3 categories according to the composition and ultrastructural appearance of glomerular deposits: 1) glomerulopathies (GP) with organized MIg deposits (immunoglobulinic [AL and AH} amyloidosis, cryoglobulinic GP, immunotactoid GP, light chain crystalline podocytopathy); 2) GP with non-organized deposits (monoclonal Ig deposition disease [LCDD, HCDD, LHCDD], proliferative glomerulonephritis with MIg deposits [PGNMID]); 3) GP without Ig deposits (MIg-associated C3GP and thrombotic microangiopathy). The diagnosis of each specific MGRS-related renal disease is suggested by the analysis of renal symptoms, particularly proteinuria, and by the presence of suggestive extra-renal manifestations. Kidney biopsy with light, immunofluorescence and electron microscopy studies, sometimes completed with proteomic analysis, is needed for diagnostic confirmation in most cases. Detailed hematologic workup is warranted for the identification and quantification of the pathogenic MIg (SPEP, UPEP, serum and urine immunofixation, serum free light chains) and for the characterization of the underlying clone (bone marrow flow cytometry, cytogenetics). Sensitive techniques such as RNA-based Ig repertoire sequencing may be useful for the detection of subtle clones. Early diagnosis and rapid achievement of deep hematological response through clone-targeted chemotherapy are the main factors influencing long-term renal and patient outcomes. Treatment of plasma cell clones mostly relies on bortezomib and anti-CD38 monoclonal antibody-based regimens, which do not require dose adaptation and have a favorable efficacy/toxicity ratio in patients with renal impairment. Renal transplantation is a valuable option in selected patients with end-stage kidney disease, providing that a deep and stable hematologic response (≥ VGPR) has been achieved prior to the procedure.
High incidence of trigger finger after carpal tunnel release: a systematic review and meta-analysis
Authors: Yu-Chieh Lo, Cheng-Han Lin, Shu-Wei Huang, Yu-Pin Chen, Yi-Jie Kuo
Journal: International Journal of Surgery (2023)

Introduction: Trigger finger (TF) often occurs after carpal tunnel release (CTR), but the mechanism and outcomes remain inconsistent. This study evaluated the incidence of TF after CTR and its related risk factors. Materials and Methods: ​PubMed, Embase, and Scopus databases were searched up to 27 August 2022, with the following keywords: “carpal tunnel release” and “trigger finger”. Studies with complete data on the incidence of TF after CTR and published full text. The primary outcome was the association between CTR and the subsequent occurrence of the TF and to calculate the pooled incidence of post-CTR TF. The secondary outcomes included the potential risk factors among patients with and without post-CTR TF as well as the prevalence of the post-CTR TF on the affected digits. Results: Ten studies with total 10,399 participants in 9 studies and 875 operated hands in one article were included for meta-analysis. CTR significantly increases the risk of following TF occurrence (odds ratio=2.67; 95% CI 2.344–3.043; P &lt;0.001). The pooled incidence of TF development after CTR was 7.7%. Women were more likely to develop a TF after CTR surgery (odds ratio=2.02; 95% CI 1.054–3.873; P =0.034). Finally, the thumb was the most susceptible fingers, followed by middle and ring fingers. Conclusions: High incidence of TF comes after CTR, and women were more susceptible than man. Clinicians were suggested to notice the potential risk of TF after CTR in clinical practice. Level of evidence: Level III, meta-analysis.
Personalized mRNA Vaccine Immunogenic against PDAC
Journal: Cancer Discovery (2023)

BioNTech's personalized mRNA vaccine, autogene cevumeran, elicited neoantigen-specific T cells in eight of 16 patients with surgically resected pancreatic ductal adenocarcinoma, leading to T-cell expansion in the bloodstream and delays in disease recurrence, according to phase I trial data. A randomized follow-up study is planned.
Prevalence of Aortic Valve Calcium and the Long-Term Risk of Incident Severe Aortic Stenosis
Authors: Seamus P. Whelton, Kunal Jha, Zeina Dardari, Alexander C. Razavi, Ellen Boakye, Omar Dzaye, Dhiran Verghese, Sanjiv Shah, Matthew J. Budoff, Kunihiro Matsushita, J. Jeffery Carr, Ramachandran S. Vasan, Roger S. Blumenthal, Khalil Anchouche, George Thanassoulis, Xiuqing Guo, Jerome I. Rotter, Robyn L. McClelland, Wendy S. Post, Michael J. Blaha
Journal: JACC. Cardiovascular imaging (2023)
Racial Inequality in Receipt of Medications for Opioid Use Disorder
Authors: Michael L. Barnett, Ellen Meara, Terri Lewinson, Brianna Hardy, Deanna Chyn, Moraa Onsando, Haiden A. Huskamp, Ateev Mehrotra, Nancy E. Morden
Journal: New England Journal of Medicine (2023)

Since 2010, Black persons in the United States have had a greater increase in opioid overdose-related mortality than other groups, but national-level evidence characterizing racial and ethnic disparities in the use of medications for opioid use disorder (OUD) is limited.We used Medicare claims data from the 2016-2019 period for a random 40% sample of fee-for-service beneficiaries who were Black, Hispanic, or White; were eligible for Medicare owing to disability; and had an index event related to OUD (nonfatal overdose treated in an emergency department or inpatient setting, hospitalization with injection drug use-related infection, or inpatient or residential rehabilitation or detoxification care). We measured the receipt of medications to treat OUD (buprenorphine, naltrexone, and naloxone), the receipt of high-risk medications (opioid analgesics and benzodiazepines), and health care utilization, all in the 180 days after the index event. We estimated differences in outcomes according to race and ethnic group with adjustment for beneficiary age, sex, index event, count of chronic coexisting conditions, and state of residence.We identified 25,904 OUD-related index events among 23,370 beneficiaries, with 3937 events (15.2%) occurring among Black patients, 2105 (8.1%) among Hispanic patients, and 19,862 (76.7%) among White patients. In the 180 days after the index event, patients received buprenorphine after 12.7% of events among Black patients, after 18.7% of those among Hispanic patients, and after 23.3% of those among White patients; patients received naloxone after 14.4%, 20.7%, and 22.9%, respectively; and patients received benzodiazepines after 23.4%, 29.6%, and 37.1%, respectively. Racial differences in the receipt of medications to treat OUD did not change appreciably from 2016 to 2019 (buprenorphine receipt: after 9.1% of index events among Black patients vs. 21.6% of those among White patients in 2016, and after 14.1% vs. 25.5% in 2019). In all study groups, patients had multiple ambulatory visits in the 180 days after the index event (mean number of visits, 6.6 after events among Black patients, 6.7 after events among Hispanic patients, and 7.6 after events among White patients).Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact. (Funded by the National Institute on Drug Abuse and the National Institute on Aging.).
Integrating Echocardiography Parameters With Explainable Artificial Intelligence for Data-Driven Clustering of Primary Mitral Regurgitation Phenotypes
Authors: Jérémy Bernard, Naveena Yanamala, Rohan Shah, Karthik Seetharam, Alexandre Altes, Marlène Dupuis, Oumhani Toubal, Haïfa Mahjoub, Hélène Dumortier, Jean Tartar, Erwan Salaun, Kim O’Connor, Mathieu Bernier, Jonathan Beaudoin, Nancy Côté, André Vincentelli, Florent LeVen, Sylvestre Maréchaux, Philippe Pibarot, Partho P. Sengupta
Journal: JACC. Cardiovascular imaging (2023)
Longitudinal Changes in Left Ventricular Diastolic Function in Late Life
Authors: Li Zhao, Rani Zierath, Brian Claggett, Pranav Dorbala, Kunihiro Matsushita, Dalane Kitzman, Aaron R. Folsom, Suma Konety, Thomas Mosley, Hicham Skali, Amil M. Shah
Journal: JACC. Cardiovascular imaging (2023)